4. 急性胸痛
概 述
胸痛是主观感觉胸部刺痛、锐痛、钝痛、闷痛或压迫感,常伴有紧张、焦虑和恐惧,是临床常见急诊症状之一。致命性胸痛可能是急性冠状动脉综合征、主动脉夹层、肺栓塞、气胸等,其中以急性冠状动脉综合征最常见。以下是急性胸痛诊治的临床路径。
表4.1 急性胸部疼痛的重点评估
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T4.1_4453.jpg?sign=1739562625-0YvtjiH8h5L74pZPiGAKfLO6rJFumFP4-0-b2e0a1761d516fedf5db1c4edb7e5ff9)
表4.2 ST段抬高型心肌梗死、早期复极综合征和急性心包炎的心电图特征
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T4.2_59943.jpg?sign=1739562625-MAdYfoRAfyAt5iBty0v98soLmwRsFhFX-0-86294c84e105cb5a83de34c970e3d2a8)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T4.2_1_59944.jpg?sign=1739562625-a6mTRP2ydrUwkyelzHDm0gsPlDJE7ZEi-0-05b8104d57aaecd5c055b72acbf7fa78)
表4.3 急性胸痛的病因
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T4.3_59945.jpg?sign=1739562625-Ym74lXlYnlJ62ZT9qh1Id8udPAdnvO1K-0-5d886c50dc7711f511e13b689469748b)
表4.4 急性胸痛的紧急检查
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T4.4_4634.jpg?sign=1739562625-AqkLnpw9Nd27Es3Z74f8tl0ecTTRU3z4-0-8330549bb38a355e02eaf9f9da301ce4)
表4.5 心肌标志物
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T4.5_59946.jpg?sign=1739562625-vZH81vSfetKSX8Q4PQXmWybTfyx4cawA-0-ae9085fb886b23599b6ab933abb71bce)
表4.6 肌钙蛋白升高的非冠状动脉因素
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T4.6_59617.jpg?sign=1739562625-LwhrxCyKA3rFK4ntn09Y1MjHBWJcHf2w-0-49762f56eba64d2f0553aa56256954ee)